Effect of left atrial and ventricular abnormalities on renal transplant recipient outcome—a single-center study

Background: Premature cardiovascular (CV) death is the commonest cause of death in renal transplant recipients. Abnormalities of left ventricular (LV) structure (collectively termed uremic cardiomyopathy) and left atrial (LA) dilation, a marker of fluid status and diastolic function, are risk factors for reduced survival in patients with end stage renal disease (ESRD). In the present analysis, we studied the impact of pre-transplant LA and LV abnormalities on survival after successful renal transplantation (RT).<p></p> Methods: One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.<p></p> Results: Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.<p></p> Conclusions: Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation.<p></p> METHODS: One hundred nineteen renal transplant recipients (first transplant, deceased donors) underwent cardiovascular MRI (CMR) as part of CV screening prior to inclusion on the waiting list. Data regarding transplant function and patient survival after transplantation were collected.<p></p> RESULTS: Median post-transplant follow-up was 4.3 years (interquartile range (IQR) 1.9, 6.2). During the post-transplant period, 13 patients returned to dialysis after graft failure and 23 patients died with a functioning graft. Survival analyses, censoring for patients returning to dialysis, showed that pre-transplant LV hypertrophy and elevated LA volume were significantly associated with reduced survival after transplantation. Multivariate Cox regression analyses demonstrated that longer waiting time, poorer transplant function, presence of LV hypertrophy and higher LA volume on screening CMR and female sex were independent predictors of death in patients with a functioning transplant.<p></p> CONCLUSIONS: Presence of LVH and higher LA volume are significant, independent predictors of death in patients who are wait-listed and proceed with renal transplantation

Dyson-Schwinger Equation and Quantum Phase Transitions in Massless QCD

We study the stability of the highest symmetric solution (Wigner-solution) of Dyson-Schwinger equations in chiral limit and at zero temperature. Our results confirm that if the chemical potential is not very large, the QCD vacuum is in the chiral symmetry breaking phase and the quantum phase-transition of the chiral symmetry restoration is in first order. Meanwhile it seems that there is not competition between chiral symmetry breaking phase and color superconductivity phase since the color superconductivity phase appears only if the chemical potential is very large. Moreover, we propose that chiral symmetry breaking arises from the positive feedback with respect to the mass perturbation.Comment: 12 pages, 6 figure

Physical Disability and Physical Activity Involvement Portrayal in the Media

Disability media studies articulates the formation of a new field of study, based in the rich traditions of media, cultural, and disability. Television, film, current periodicals, and other mass media are a part of our everyday lives. Attitudes regarding a variety of issues can be affected by these media, not the least of which are attitudes toward disability. Media is a significant part of contemporary society and culture and is subsequently crucial to our understanding of disability. The representation of disability in the media in the last ten years is pretty much the same as it has always been: clichéd, stereotyped, and archetypal. Media representation of and for the disabled has been recharged in recent years with the expansion of new media worldwide. Interactive digital communications [such as the Internet, new varieties of voice and text telephones, social media, and digital broadcasting] have created a need to explore the constructs of media and the media relationship with disability. To explore this topic, we asked the same questions posed by scholars, how exactly does the media interact with disability and vice versa? Does the media adequately reflect the lives of people with disabilities

The Quark Propagator from the Dyson-Schwinger Equations: I. the Chiral Solution

Within the framework of the Dyson-Schwinger equations in the axial gauge, we study the effect that non-perturbative glue has on the quark propagator. We show that Ward-Takahashi identities, combined with the requirement of matching perturbative QCD at high momentum transfer, guarantee the multiplicative renormalisability of the answer. Technically, the matching with perturbation theory is accomplished by the introduction of a transverse part to the quark-gluon vertex. We show that this transverse vertex is crucial for chiral symmetry breaking, and that massless solutions exist below a critical value of the strong coupling constant. Using the gluon propagator that we previously calculated, we obtain small corrections to the quark propagator, which keeps a pole at the origin in the chiral phase.Comment: 21 pages, 6 figures; McGill/94-24, SHEP 93/94-26 We generalise our results by showing that they are not sensitive to the specific choice that we make for the transverse vertex. We illustrate that fact in two new figure

Inequalities in COVID19 mortality related to ethnicity and socioeconomic deprivation - pre-print paper

Background: Initial reports suggest that ethnic minorities may be experiencing more severe coronavirus disease 2019 (COVID19) outcomes. We therefore assessed the association between ethnic composition, income deprivation and COVID19 mortality rates in England. Methods: We performed a cross-sectional ecological analysis across England's upper-tier local authorities. We assessed the association between the proportion of the population from Black, Asian and Minority Ethnic (BAME) backgrounds, income deprivation and COVID19 mortality rates using multivariable negative binomial regression, adjusting for population density, proportion of the population aged 50-79 and 80+ years, and the duration of the epidemic in each area. Findings: Local authorities with a greater proportion of residents from ethnic minority backgrounds had statistically significantly higher COVID19 mortality rates, as did local authorities with a greater proportion of residents experiencing deprivation relating to low income. After adjusting for income deprivation and other covariates, each percentage point increase in the proportion of the population from BAME backgrounds was associated with a 1% increase in the COVID19 mortality rate [IRR=1.01, 95%CI 1.01-1.02]. Each percentage point increase in the proportion of the population experiencing income deprivation was associated with a 2% increase in the COVID19 mortality rate [IRR=1.02, 95%CI 1.01-1.04]. Interpretation: This study provides evidence that both income deprivation and ethnicity are associated with greater COVID19 mortality. To reduce these inequalities, Government needs to target effective control and recovery measures at these disadvantaged communities, proportionate to their greater needs and vulnerabilities, during and following the pandemic

Smoking Cessation: A Comparison of Two Model Structures

BACKGROUND: Most economic evaluations of smoking cessation interventions have used cohort state-transition models. Discrete event simulations (DESs) have been proposed as a superior approach. OBJECTIVE: We developed a state-transition model and a DES using the discretely integrated condition event (DICE) framework and compared the cost-effectiveness results. We performed scenario analysis using the DES to explore the impact of alternative assumptions. METHODS: The models estimated the costs and quality-adjusted life years (QALYs) for the intervention and comparator from the perspective of the UK National Health Service and Personal Social Services over a lifetime horizon. The models considered five comorbidities: chronic obstructive pulmonary disease, myocardial infarction, coronary heart disease, stroke and lung cancer. The state-transition model used prevalence data, and the DES used incidence. The costs and utility inputs were the same between two models and consistent with those used in previous analyses for the National Institute for Health and Care Excellence. RESULTS: In the state-transition model, the intervention produced an additional 0.16 QALYs at a cost of £540, leading to an incremental cost-effectiveness ratio (ICER) of £3438. The comparable DES scenario produced an ICER of £5577. The ICER for the DES increased to £18,354 when long-term relapse was included. CONCLUSIONS: The model structures themselves did not influence smoking cessation cost-effectiveness results, but long-term assumptions did. When there is variation in long-term predictions between interventions, economic models need a structure that can reflect this

How health inequalities accumulate and combine to affect treatment value: A distributional cost-effectiveness analysis of smoking cessation interventions

Introduction Reduction of health inequality is a goal in health policy, but commissioners lack information on how policies change health inequality. This study illustrates how decision models can be readily extended to produce information on health inequality impacts as well as for population health, using the example of smoking cessation therapies. Methods We retrospectively adapt a model developed for public health guidance to undertake distributional cost effectiveness analysis. We identify and incorporate evidence on how inputs vary by area-level deprivation. Therapies are evaluated in terms of total population health, extent of inequality, and a summary measure of equally distributed equivalent health based on a societal value for inequality aversion. Last, we examine how accounting for social variation in different sets of parameters affects our results. Results All interventions increase population health and increase the slope index of inequality. At estimated levels of health inequality aversion for England, our results indicate that the increases in inequality are compensated by the health gains. Discussion The inequality impacts are driven by higher benefits of quitting and higher intervention uptake amongst advantaged groups, despite the greater proportion of smokers in disadvantaged groups. Failure to account for differential effects between groups leads to different conclusions about health inequality impact but does not alter conclusions about value for money

Mediators of socioeconomic inequalities in preterm birth: a systematic review.

BackgroundRates of preterm birth are substantial with significant inequalities. Understanding the role of risk factors on the pathway from maternal socioeconomic status (SES) to preterm birth can help inform interventions and policy. This study therefore aimed to identify mediators of the relationship between maternal SES and preterm birth, assess the strength of evidence, and evaluate the quality of methods used to assess mediation.MethodsUsing Scopus, Medline OVID, "Medline In Process & Other Non-Indexed Citation", PsycINFO, and Social Science Citation Index (via Web of Science), search terms combined variations on mediation, socioeconomic status, and preterm birth. Citation and advanced Google searches supplemented this. Inclusion criteria guided screening and selection of observational studies Jan-2000 to July-2020. The metric extracted was the proportion of socioeconomic inequality in preterm birth explained by each mediator (e.g. 'proportion eliminated'). Included studies were narratively synthesised.ResultsOf 22 studies included, over one-half used cohort design. Most studies had potential measurement bias for mediators, and only two studies fully adjusted for key confounders. Eighteen studies found significant socioeconomic inequalities in preterm birth. Studies assessed six groups of potential mediators: maternal smoking; maternal mental health; maternal physical health (including body mass index (BMI)); maternal lifestyle (including alcohol consumption); healthcare; and working and environmental conditions. There was high confidence of smoking during pregnancy (most frequently examined mediator) and maternal physical health mediating inequalities in preterm birth. Significant residual inequalities frequently remained. Difference-of-coefficients between models was the most common mediation analysis approach, only six studies assessed exposure-mediator interaction, and only two considered causal assumptions.ConclusionsThe substantial socioeconomic inequalities in preterm birth are only partly explained by six groups of mediators that have been studied, particularly maternal smoking in pregnancy. There is, however, a large residual direct effect of SES evident in most studies. Despite the mediation analysis approaches used limiting our ability to make causal inference, these findings highlight potential ways of intervening to reduce such inequalities. A focus on modifiable socioeconomic determinants, such as reducing poverty and educational inequality, is probably necessary to address inequalities in preterm birth, alongside action on mediating pathways

Collision times in pi-pi and pi-K scattering and spectroscopy of meson resonances

Using the concept of collision time (time delay) introduced by Eisenbud and Wigner and its connection to on-shell intermediate unstable states, we study mesonic resonances in pi-pi and pi-K scattering. The time-delay method proves its usefulness by revealing the spectrum of the well-known rho- and K*-mesons and by supporting some speculations on rho-mesons in the 1200 MeV region. We use this method further to shed some light on more speculative meson resonances, among others the enigmatic scalars. We confirm the existence of chiralons below 1 GeV in the unflavoured and strange meson sector.Comment: 22 pages LaTex, 8 figure